Unit-Based High Fidelity Simulation

For graduate nurses, does the use of high-fidelity simulators compared to low-fidelity simulators lead to better non-technical skills during emergency situation/code blue within ten weeks?

In the late 1980’s a study was performed by Lois Haggerty. Haggerty is a masters prepared nurse who wanted to study the differences of response to patient situations in different types of nursing education programs. Her study prompted a push for more research on this issue and for the increase in baccalaureate prepared nurses. The study began with 44 ADN and 31 BSN students preparing to graduate. They were presented with four case studies. They watched two videos of patients expressing somatic distress and two videos of patients expressing non-somatic distress. They were prompted to fill out a questionnaire for each scenario stating what they would say first to each patient. Haggerty discovered that both the ADN

The first pattern of knowing in nursing presented is the Empirics: the science of nursing. Carper (1978) described this empirical knowing as factual evidence and proven medical research or documentation used for patient treatment. This empirical knowledge is vastly related explanations and predictions from facts and things that have been proven. This author believes that most of this scientific evidence or knowledge stems from books and clinical experiences gained in healthcare facilities under the leadership of trained educators or licensed medical providers. This author believes this because as a nursing student, she will learn nursing techniques such as inserting foley catheters, and doing injections first by observing the nursing

Advanced Beginner is the next stage in Patricia Benner’s model. Nurses considered to be in this stage have had enough real life experiences to note different aspects of a situation. They base their assessments of patients on previous experiences similar to the current patient they are providing care for (Benner, 1984). Nurses performing at this

For years nurses have gained experience in the medical field through clinical rounds at hospitals and doctors offices. Learning has always taken place first through textbooks and then through personal experience during required clinical time. These methods have proven effective but include limitations to the amount of exposure a student can gain before entering the workforce. A new way of learning is on the rise with the use of High Fidelity Simulations (HFS) or the Sim Man. HFS is a computerized life size manikin that simulates real human responses to treatment. This new technology allows students to practice rare procedures or treat common diagnoses.

An employer survey of Baccalaureate Nursing program at the University of Southern Indiana noted the “students lacked confidence in the acute care setting collaborating and prioritizing patient care as a member of a health care team”. 2 High-fidelity clinical simulation offers an excellent opportunity for inexperienced allied health teams to practice demanding clinical simulations without jeopardizing patient care outcomes. This type of shared learning provided early in one’s educational experience facilitates interdisciplinary collaboration, which is crucial to satisfactory patient

Second, Benner et al (2009) describe the advanced beginner level as a nurse who has acquired their degree and starting out in practice, as a newly graduated nurse with significant experience. The advanced beginner will begin to understand the important features to this level, to differentiate between this level and the novice level Benner called these features situational because the focus of this model is the actual performance of the nurse and the results that occur in a specific situation. For example, the nurse begins to recognize changes that occur before any obvious complications develop (intuition); this is possible when the nurse has had a sufficient amount of hands on experience. Finally, at this level a mentor will prepare the advanced beginner with further guidelines in their clinical profession. However, the advanced beginner is still attempting to organize the importance of tasks that need completing for the patient and the different stages of the illness the patient goes through. Furthermore, Baltimore (2004) indicates that current work places are encountering insufficient orientation adding, to the challenges the nurse is already experiencing.

Hospitals are working towards a more team-based training. The last couple years most of my training has been in a simulation lab. I feel it improves communication, teamwork, reinforces skills and new practices. Hands-on simulation experience allows healthcare workers to get messy, make mistakes and sharpen problem-solving skills — with no risk to patients. As nurses, we collaborate with each other on a daily basis but we are trained and tested individually on our skills, theory, and practical situations. As healthcare evolves, stimulation labs should be part of all healthcare works training and testing, that way everyone is better prepared to handle real time events.

Ang &Devi, 2012). The registered nurses have also complained of substandard staffing units which are not adequate to cope with the patient load (Toh, Ang &Devi, 2012). Therefore, healthcare organizations should work promptly in improving the nurse's efficacy in specialty units through consistent training and development (Toh, Ang &Devi, 2012). The continuous training and education of nurses are essential to organize the workload and to improve the working environment of emergency and specialty departments such as ICU (Toh, Ang &Devi, 2012).

The aim of this essay is to reflect and discuss my knowledge acquired in a simulated learning skill experience which forms part of my training as a student nurse in accordance with the Nurses and Midwifery Council (NMC 2010).

My chosen practicum will be teaching in the skills/simulation lab at NCMC. This paper will outline how the experience will enhance my knowledge and develop skills necessary to fulfill the role of nurse educator. The goals, objectives, and timeline will be discussed in this paper. The project that will be developed during the practicum experience will be a debriefing philosophy and evaluation tool to assess student learning with emphasis on critical thinking skills.

The intent of clinical simulations is to provide a safe environment for students to practice and implement skills. This is a way in which to help prepare the student for the hospital setting. Enhanced confidence, clinical judgment, knowledge, and competence are factors that come from these situations. I gained further knowledge, but I did not experience the other skills during simulation. During the postpartum-hemorrhage and birthing simulation, I purposefully picked the scenarios that I felt most comfortable with. That entailed being the spouse of the woman in labor, the nursing assistant, and the patient’s family member. When embodying those roles, I felt at ease, because I was not the fixation; I was not the one in charge of the situation. During the preeclampsia simulation, I was “dubbed” the staff nurse. I was definitely out of my comfort zone. I was in the second group, and this allowed me to observe the first group. I learned and made alterations from the first group’s performance. Observing the first group helped, but my performance was poor. I made several mistakes and was embarrassed by the end result. I did not do well with the assessments, answering the patient’s questions appropriately, and when calling the doctor, I was not fully prepared. Despite all the mistakes and feelings of embarrassment, I learned. I am very thankful for the awareness of what things went wrong. With further practice and

This is very interesting topic! High fidelity simulation is a tool that we will use as part of our training. Thus, knowing how close to reality is the level of stress of simulation is essential. As you mention, practice opportunities for students are decreasing due to safety issues. However, high fidelity simulation will impact learner’s self-confidence. A questionnaire is a great way to know how truthful the experience was. It will be interesting to see the answers of practicing CRNAs to the questionnaire about their simulation lab experience. Great topic!!

For the next simulation, I am hoping that I have improved my critical thinking skills in nursing to effectively perform whatever role I will have. Moreover, since simulations are actual situations in real life clinical settings that are being played out by the students, I will research on applicable evidenced based nursing intervention and applied it during the simulation. Applying this type of intervention during the simulation will reinforce my knowledge of effective nursing intervention and will enable me to acquire a more meaningful experience that could be applied in actual clinical setting. I will also try my very best to find out what possible equipment will be used in carrying out nursing care for a given clinical

McGrath, M., Lyng, C., & Hourican, S. (2012, September). From the simulation lab to the ward: Preparing 4th year nursing students for the role of staff nurse. Clinical Simulation in Nursing, 8(7), e265-e272.